Urgent and services at Guy's and St Thomas' begin at the front door where arrivals are assessed by a healthcare professional (if arriving by foot) and then streamed to the most important area.

Patients arriving by ambulance are handed over to a nurse on arrival and a decision is then made about where they should be sent.

‘We've had some difficult days recently but fundamentally we get our ambulances offloaded as soon as humanly possible so that patients are transferred into a cubicle or into the right area for them,' Dr Henderson said.

GP centre

One option for patient streaming is St Thomas' GP centre.  

‘We've had that for a few years,' Dr Henderson explained.

‘It's not immediately on the emergency floor, so it's very much for patients who would be having a primary care encounter, but it just means that you've got more options for people to be seen by somebody on the day.

‘The art of it is to get it right on the first pass so that the patient ends up in the right area.'

The comeback rate to the emergency department of patients sent to the GP centre is closely monitored so Dr Henderson and her teams can assess whether they are being risky or too risk averse.

‘We would expect less than one in 10 of those patients to come back and we usually run, for example, at 7%,' the clinical director said.

While patients are actively encouraged to attend a particular area, there is always the flexibility to move people someone else should their condition require it.

‘We don't have corridor care'

Guy's and St Thomas takes a ‘whole trust bed management' approach to ensuring it has no corridor care.

‘That's isn't just down to the emergency department, that's very much down to an executive led red line in the sand,' Dr Henderson said.

‘If it's looking like we're really running out of space, we have an escalation for ambulance offloads at 45 minutes before the 45 minutes is up and really push to get patients onto the wards.'

Community partners

The trust was praised by the CQC for its particular attention to individual needs and for partnering with community organisations to address health inequalities.

‘We are part of the community the way the trust runs so we have a lot of relationships with community providers,' Dr Henderson said.

‘We've got a really good homeless team. We've got our psych liaison team. We've got our addictions team. We've got our substance abuse team. We've got a big toxicology team, because we also have a lot of drug presentations, so we've got a lot of pathways that we've identified as relevant to our local population and then we work to provide that care for them specifically.'

‘Single biggest challenge'

While having particular pathways for specialty groups, Dr Henderson acknowledged  provision of mental health beds was the trust's ‘single biggest challenge'.

The clinical director admitted mental health was the only area where Guys and St Thomas regularly exceeds 12-hour waits.

‘Our psychiatry liaison team are excellent and work incredibly hard, but if a patient needs an inpatient bed, it depends on their postcode, and because we're very central London, near hubs of transport, etc, we often get people from all around the country,' Dr Henderson said.

Social care remains another area of exit block for Guy's and St Thomas like many hospitals.

‘We do have problems with that but we try and manage our beds as tightly as we possibly can and make sure we escalate everywhere that we can to get patients the best outcome because staying in hospital is often not the best outcome,' Dr Henderson said.

‘You don't want to keep people in hospital a moment longer than you have to but that's still quite a struggle.'

Leadership praise

In its inspection, the CQC also praised the trust for investing heavily in the skills and wellbeing of staff, something which Dr Henderson is particularly proud of.

‘What I was proudest of was people saying that they're proud to work here,' Dr Henderson concluded.

‘We have stressful days. We have violence aggression, like everybody, but people saying that they're proud to work here warms my heart in a big way. That's a really lovely thing for people to be saying.'

If you want to share the secrets of your success, contact l.peart@hgluk.com